Three patients, men aged 30, 33 and 32 years respectively, died in police custody in Amsterdam, the Netherlands. According to autopsy reports, all patients died from excited delirium syndrome induced by cocaine use. Excited delirium is a state of mental and physiological hyperarousal commonly associated with the use of cocaine. Patients suffering from excited delirium can be extremely hostile and violent. If a physical struggle arises with police or medical personnel, the episode can end in death due to adrenergic overstimulation. Patients in acute excited states should be regarded as a medical emergency with a serious mortality risk, and should be transferred to the hospital rather than the police station. Medical and police staff should aim to reduce confrontation. When patients are too agitated to cooperate, benzodiazepines should be used for sedation of the patient. Beta blockers and antipsychotic medication should not be administered, as these medications can exacerbate the fatal cardiac effects seen in excited delirium.